The present invention generally relates to medical devices, and more particularly to bladder control devices, and still more particularly to an indwelling urinary flow control device for the treatment of urinary incontinence.
Although a variety of treatment devices and/or methodologies have been developed, urinary incontinence for both men and women remains a persistent problem. Heretofore known approaches to the problem are generally recognized as either remedial or corrective. Remedial approaches (i.e., those primarily dealing with the effects of incontinence) have primarily included the use of catheters in combination with collection bags or the like. As circumstances warrant, the wearing of special fluid retaining pants has been an option, all be it an undesirable one, for both social and practical reasons.
Remedial approaches are almost always less attractive than corrective approaches, which generally require the placement or implantation of an indwelling device within the urethra. In general terms, it is the goal of such devices to provide a valving system for a patient""s bladder, which system is placed directly in the urethra, and adjacent the bladder. The valving system is ideally activated by the patient upon sensing an urge to urinate, such urge being generally generated at about 20 centimeters of water pressure (20 cm H2O), and deactivated when the bladder has been sufficiently emptied.
Some of the problems and disadvantages of known devices include the deleterious effects (i.e., pitting, depositions, etc.) associated with the urethral environment upon critical device components (e.g., valve actuators, flow conduits, etc.) which at a minimum render such devices less effective, and which at a maximum, cause device component failure or render the device wholly ineffective, which necessitates emergent removal and, as the case may be, urinary tract damage repair. Problems of device leakage, or less than complete emptying of the bladder are also widely known. Furthermore, issues surrounding device deployment and fit, positioning, repositioning, and retention (i.e., sufficient anchoring) have also been well documented.
Device features are primarily dictated by the anatomical and physiological environment into which they are to be placed. In light of know devices and methodologies, it has become better appreciated that there are several essential requirements which must be met for an indwelling urinary flow control device so as to be effective.
First, the flow control device must not completely occlude urethral passage when intra-bladder pressures are excessive for an extended period of time. It is a widely held view among clinical urologists that on occasions when the bladder is pressurized to beyond approximately 40 cm H2O for more than about 2 hours, an individual is in danger of permanent injury to the kidneys. For this reason, it is desirable for a flow control device to allow passage of at least as much urine, volumetrically, as is being produced by the kidneys once the bladder pressure has reached a threshold value (i.e., approximately 40 cm H2O).
Second, physical straining due to lifting, laughing, coughing, and other xe2x80x9cexertionsxe2x80x9d may produce inter-abdominal forces on the bladder, which may translate to pressures in excess of 40 cm H2O for a short time interval or duration. Such inadvertent stresses must not cause appreciable leakage, even though they may momentarily exceed approximately 40 cm H2O for short durations. Such pressure surges are a natural event, which may be frequently encountered.
Third, the flow control device must allow for remote or natural initiation without physically touching or otherwise contacting the flow control device in order to provide the most protection against introduction of bacteria, which would be likely to contribute to urinary tract infections (UTIs). It is further advantageous that the initiation be painless, sterile, non-invasive, repeatable, not dependent upon hardware that is expensive, cumbersome, difficult to operate or objectionable.
Fourth, the flow control device must be stable with respect to position (i.e., a physiologically properly deployed and stable position), and comfortable to wear, as the urinary tract is sensitive to contact. Inter-urethral stents have been utilized within the male urethra within the prostatic region with many users foregoing such devices for alternate therapies due to feelings of discomfort and/or pain. Many flow control devices have similarly been evaluated for urinary incontinence for females. Based upon clinical findings, many have been shown to be uncomfortable, thus severely retarding their utility as a therapy. Other devices have migrated into the bladder, or have been expelled under straining conditions.
Fifth, flow control devices must have longevity of operation. Working components that are exposed to urine are susceptible to encrustation, which may compromise device operation and thereby place a wearer at risk of injury or even death. Intraurethral flow control devices must not quickly lose functional operation due to either mechanical failure, or blockage of flow passages. This is exceedingly important for a male due to the more difficult, and more inconvenient, removal associated with typical flow control devices.
A urinary flow control device having a bladder responsive flow control assembly operatively engaged with an elongate member having proximal and distal ends, and a lumen capable of discharging urine therethrough is provided. The flow control assembly includes first and second fluid containing compartments adapted to be in fluid communication. The flow control assembly is adapted to receive and contain urine from a bladder so as to impinge upon the first fluid containing compartment. The flow control assembly is responsive to increased bladder pressure such that fluid is displaced from the first fluid containing compartment to the second fluid containing compartment to thereby permit select passage of received urine to the lumen of the elongate member for discharge therethrough. A method of controlling urinary flow is likewise provided.
Alternate embodiments of the device are primarily directed to alternate encasements thereof. More particularly, the exterior surface of the devices are adapted for ease of placement, namely secured placement via an anchoring mechanism. It is especially advantageous that the anchoring mechanism be responsive to variations in anatomy. Although this may be the case, a common operational premises underlays each.
The device and method of the subject invention provides for flow initiation subject to the flow related criteria previously detailed by providing, among other things, functions that are two fold and parallel. First, the subject device provides a unique design and function in which the critical switching elements of the flow control assembly, namely the mechanisms associated with the first and second fluid containing components, are sealed from the urine. Functionally, flow initiation is accomplished by magnetically opening a passageway within a sealed system which allows the xe2x80x9cunlatchingxe2x80x9d of the device by the release of a fluid locked or blocked condition within a first closed system (i.e., first fluid containing compartment).
Unlatching occurs when an external switch actuator (e.g., a magnet) is introduced exterior but proximal to the body (e.g., in the case of magnetic actuating means, to the anterior region of the body near the pubic bone). Urine flow then begins as the first fluid containing compartment is allowed to deform (i.e., partially collapse) due to fluid being hydraulically shuttled from the first fluid compartment to an adjacent reservoir (i.e., from the first to second fluid containing compartments). This dynamic device configuration permits urine to pass from the bladder and to the urethra for discharge, with the xe2x80x9cworkxe2x80x9d required to deflect the first fluid containing compartment and transport fluid from the first to second compartment provided by the internal pressure within the bladder.
When the external magnet is removed, the device will not prohibit discharge of urine from the bladder to the urethra during urination, or immediately post urination, but only when the external magnet is again brought into communication with the device. This assures complete emptying of the bladder without requiring continual straining, even when the natural micturation episode of the bladder is concluded. In the event that a user""s bladder will not produce sufficient pressure to empty his or her bladder, use of the subject device permits a more complete drainage of the bladder of urine. When urination or voiding is complete, the user simply brings in the external magnet to xe2x80x9cunlatchxe2x80x9d the device a second time. After a brief period the device will be reset into its static configuration. This occurs due to the pressure responsiveness of the flow control assembly, particularly the fact that the first fluid containing member is dynamically responsive to bladder pressure (i.e., will return to a pre-collapsed, reset condition). With the external magnet removed, the device is thereby reset (i.e., placed in a static configuration) so as to withstand the filling pressure within the bladder.
The subject invention allows for the isolation of the critical functional components from the severe corrosive environment encountered within the bladder and urethra. The magnetic latching function of this device does not provide the work to move fluid, but rather enables or disables the movement which must occur internal to the fluid control assembly to permit controlled, or at least regulated, passage of urine from the bladder into the urethra.
A further desirable feature of the embodiments of the subject invention is the relief of over pressurization within the bladder, while simultaneously protecting the patient from involuntary openings when pressure surges occur due to laughing, or sneezing. This control is provided by selectively allowing the limited displacement of the fluid control assembly components at discrete predetermined pressures or pressure ranges.
The material characteristics and geometry of the first fluid containing compartment specifically determine the initiation pressure for over-pressure or venting flow. When sufficient fluid is transported between the fluid containing compartments, a relative collapse of the first fluid containing compartment will manifest, and a controlled passage (i.e., leakage) of urine from the bladder to the urethra will occur. The extent of leakage is regulated by the volume of fluid that is transferred (i.e., displaced) into the second fluid containing compartment as a function of time in an over-pressure event. Upon relief of excess pressure, the first fluid containing compartment tends towards its static configuration so as to cause vacuum motivated retrieval of the fluid from the second fluid containing compartment into the first fluid containing compartment, thereby returning the device to a static configuration representative of an equilibrium condition or status.
The device of the subject invention may be configured with features of co-pending applications Ser. No. 09/411,491, xe2x80x9cDevice with Anchoring Systemxe2x80x9d; Ser. No. 09/340,491, xe2x80x9cApparatus with Position Indicator and Methods of Use Thereofxe2x80x9d which is a continuation of U.S. Pat. No. 5,964,732; and, No. 60/168,306, xe2x80x9cMagnetic Retrieval Device and Method of Usexe2x80x9d, the entire disclosures of which are incorporated herein by reference.
The foregoing and other objects, features, and advantages of the invention will be apparent with reference to the figures and from the following DETAILED DESCRIPTION OF THE INVENTION. The figures are not necessarily to dimensional or geometric scale, nor do they necessarily represent structures in accurate or representative relative scale. Emphasis rather is placed upon illustrating principals of the invention in a clear manner.